Provider Demographics
NPI:1346388428
Name:ROSENAU, SUSAN RENEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:ROSENAU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HIGHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLUE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56013
Mailing Address - Country:US
Mailing Address - Phone:507-526-3950
Mailing Address - Fax:
Practice Address - Street 1:322 S STATE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4139
Practice Address - Country:US
Practice Address - Phone:507-238-2797
Practice Address - Fax:507-238-4701
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117225-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN117225-4OtherPHARMACY LICENSE